State health law hasn't cut ER traffic

Friday

Sep 25, 2009 at 12:01 AM

NEW BEDFORD — The state's mandatory health insurance law hasn't made a dent in the traffic at emergency rooms in Massachusetts, according to a report released Thursday by the Blue Cross Blue Shield of Massachusetts Foundation.

STEVE URBON

NEW BEDFORD — The state's mandatory health insurance law hasn't made a dent in the traffic at emergency rooms in Massachusetts, according to a report released Thursday by the Blue Cross Blue Shield of Massachusetts Foundation.

Southeastern Massachusetts was second, after Boston, in the percentage of adults 18 to 64 who made an emergency room visit in the past 12 months. The percentage in Boston was 40.3 percent, in the Southeast 38.1 percent.

Almost all of those patients have health insurance, said the report.

The report wasn't news to hospital officials, who for some time have been stepping up efforts to improve access to primary care physicians for routine visits and for follow-up care after visits to the ER or hospital stays. But with more than 4,000 people surveyed, it did reveal in better detail who uses emergency rooms and why, giving policy makers more data to better target their efforts.

The survey found that those who use the emergency room the most — three times in a year — are only 8 percent of the working-age population, yet they account for 24 percent of the ER traffic. They are sicker, more disabled, less likely to have a primary care physician. They are low income, low education, with public health coverage or are uninsured.

"They are more likely to rely on hospital out-patient departments, community health centers, and other public clinics as their usual source of care," said a spokeswoman for the foundation in a briefing paper.

Diverting non-emergency care from expensive emergency rooms is a high priority for health planners, but Massachusetts ranks 44th out of the 50 states in the percentage of people who use emergency rooms, with first being the lowest usage, and in turn Boston and Southeast Massachusetts rank worst in the state.

In this region, 51.1 percent of the emergency room visits were deemed non-emergency, while the figure statewide was 44 percent. Patients gave several reasons. Three-quarters of them said they needed care after normal operating hours for doctors' offices. Slightly more than half said they couldn't get a doctor's appointment soon enough. Just over half said it was simply for convenience. And 39 percent had been told by their primary care physician to go to the emergency room.

In response to these conditions, Southcoast Hospitals — Tobey in Wareham, Charlton in Fall River and St. Luke's — have been bringing in reinforcements. "We have recruited a phenomenal number, something like 20, primary care physicians in the last year," said spokeswoman Joyce Faria Brennan.

They work with the hospitals as Southcoast Physician Services and the Southcoast Physician Network, improving access for people who might otherwise rely on hospital out-patient departments, community health centers or other public clinics, who are more likely to resort to emergency rooms.

Brennan said, "It's not fancy but it's the best way for more people to get a primary physician, especially with Commonwealth Care," the state-subsidized insurance plan.

Wendy Bauer, spokeswoman for St. Anne's Hospital in Fall River, said that something similar is happening there. A community needs assessment last spring revealed the reasons for excessive emergency room traffic, she said.

In response, the hospital has set up a system where patients can get an urgent care visit with a physician within 24 hours. That includes emergency room patients who need a follow-up.

"In the last five years we have very actively been trying to enlarge and expand our primary care physician network," Bauer said. "That includes a number of physicians fluent in Portuguese and Spanish, and nurse practitioners.

"We've also launched the Caritas Skilled Care Team, where a team of nurse practitioners can visit patients in nursing homes. That relieves the primary care physician from having to do the nursing home visits, which is another reason they are not available in their offices," Bauer said.

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